<!-- INCLUDE header.html -->

<div id='content'>
	<!-- INCLUDE left.html -->
	<div id="right">
		<div class="page-title">Checkout Step 1</div>
		<div class="page-wrapper">
			<div class="error">{$msg}</div>
			<form action="?confirmation" method="post" onsubmit="return check_form(this);">
			<table border="0" cellpadding="0" cellspacing="3" class="text">			  
				<tr>
					<td colspan="2" height="40" valign="bottom"><strong>Billing Information </strong></td>
				</tr>
				<tr>
					<td   >&nbsp;First Name:</td>
					<td  >
						<input name="billing[fname]" required="true"  type="text" class="text" rel="fname"   value="" />*
					</td>
				</tr>
				<tr>
					<td  >&nbsp;Last Name:</td>
					<td >
						<input name="billing[lname]"  required="true"  type="text" class="text"  rel="lname"   value=""/>* 
					</td>
				</tr>
				<tr>
			        <td   >&nbsp;Street:</td>
					<td  >
						<input name="billing[street]"  required="true"  type="text" class="text"  rel="street" / value="">
					* (include apt #, if you have) 
					</td>
				</tr>
				
				<tr>
					<td  >&nbsp;City:</td>
					<td >
						<input name="billing[city]"  required="true"  type="text" class="text"  rel="city" / value="">*
					</td>
				</tr>
				
				<tr>
					<td  >&nbsp;State:</td>
					<td >
						<select name="billing[states]"  class="text" rel="states">
			                                  <option value="AL" >Alabama</option>

			                                  <option value="AK" >Alaska</option>
			                                  <option value="AZ" >Arizona</option>
			                                  <option value="AR">Arkansas</option>
			                                  <option value="CA">California</option>
			                                  <option value="CDA">Canada</option>
			                                  <option value="CO">Colorado</option>

			                                  <option value="CT">Connecticut</option>
			                                  <option value="DE">Delaware</option>
			                                  <option value="DC">District of Columbia</option>
			                                  <option value="FL">Florida</option>
			                                  <option value="GA">Georgia</option>
			                                  <option value="HI">Hawaii</option>

			                                  <option value="ID">Idaho</option>
			                                  <option value="IL">Illinois</option>
			                                  <option value="IN">Indiana</option>
			                                  <option value="IA">Iowa</option>
			                                  <option value="KS">Kansas</option>
			                                  <option value="KY">Kentucky</option>

			                                  <option value="LA">Louisiana</option>
			                                  <option value="ME">Maine</option>
			                                  <option value="MD">Maryland</option>
			                                  <option value="MA">Massachusetts</option>
			                                  <option value="MI">Michigan</option>
			                                  <option value="MN">Minnesota</option>                                  <option value="MS">Mississippi</option>
			                                  <option value="MO">Missouri</option>
			                                  <option value="MT">Montana</option>
			                                  <option value="NE">Nebraska</option>
			                                  <option value="NV">Nevada</option>
			                                  <option value="NH">New Hampshire</option>

			                                  <option value="NJ">New Jersey</option>
			                                  <option value="NM">New Mexico</option>
			                                  <option value="NY">New York</option>
			                                  <option value="NC">North Carolina</option>
			                                  <option value="ND">North Dakota</option>
			                                  <option value="OH">Ohio</option>

			                                  <option value="OK">Oklahoma</option>
			                                  <option value="OR">Oregon</option>
			                                  <option value="PA">Pennsylvania</option>
											  <option value="PR" >Puerto Rico</option>
			                                  <option value="RI">Rhode Island</option>
			                                  <option value="SC">South Carolina</option>

			                                  <option value="SD">South Dakota</option>
			                                  <option value="TN">Tennessee</option>
			                                  <option value="TX">Texas</option>
			                                  <option value="UT">Utah</option>
			                                  <option value="VT">Vermont</option>
			                                  <option value="VA">Virginia</option>

			                                  <option value="WA">Washington</option>
			                                  <option value="WV">West Virginia</option>
			                                  <option value="WI">Wisconsin</option>
			                                  <option value="WY">Wyoming</option>
			                                </select>            * 
					</td>
				</tr>
				
				<tr>
					<td  >&nbsp;ZipCode: </td>
					<td >
						<input name="billing[zip]"  required="true"  type="text" class="text"  rel="zip" maxlength="5"  value=""/>*
					</td>
				</tr>
				
				<tr>
					<td colspan="2" height="40" valign="bottom"><strong>Shipping Information</strong></td>
				</tr>
				
				
				<tr>
					<td   >&nbsp;First Name:</td>
					<td  >
						<input name="shipping[fname]" required="true"  type="text" class="text" rel="fname"   value="" />*
					</td>
				</tr>
				<tr>
					<td  >&nbsp;Last Name:</td>
					<td >
						<input name="shipping[lname]"  required="true"  type="text" class="text"  rel="lname"   value=""/>* 
					</td>
				</tr>
				<tr>
			        <td   >&nbsp;Street:</td>
					<td  >
						<input name="shipping[street]"  required="true"  type="text" class="text"  rel="street" / value="">
					* (include apt #, if you have) 
					</td>
				</tr>
				
				<tr>
					<td  >&nbsp;City:</td>
					<td >
						<input name="shipping[city]"  required="true"  type="text" class="text"  rel="city" / value="">*
					</td>
				</tr>
				
				<tr>
					<td  >&nbsp;State:</td>
					<td >
						<select name="shipping[states]"  class="text" rel="states">
			                                  <option value="AL" >Alabama</option>

			                                  <option value="AK" >Alaska</option>
			                                  <option value="AZ" >Arizona</option>
			                                  <option value="AR">Arkansas</option>
			                                  <option value="CA">California</option>
			                                  <option value="CDA">Canada</option>
			                                  <option value="CO">Colorado</option>

			                                  <option value="CT">Connecticut</option>
			                                  <option value="DE">Delaware</option>
			                                  <option value="DC">District of Columbia</option>
			                                  <option value="FL">Florida</option>
			                                  <option value="GA">Georgia</option>
			                                  <option value="HI">Hawaii</option>

			                                  <option value="ID">Idaho</option>
			                                  <option value="IL">Illinois</option>
			                                  <option value="IN">Indiana</option>
			                                  <option value="IA">Iowa</option>
			                                  <option value="KS">Kansas</option>
			                                  <option value="KY">Kentucky</option>

			                                  <option value="LA">Louisiana</option>
			                                  <option value="ME">Maine</option>
			                                  <option value="MD">Maryland</option>
			                                  <option value="MA">Massachusetts</option>
			                                  <option value="MI">Michigan</option>
			                                  <option value="MN">Minnesota</option>                                  <option value="MS">Mississippi</option>
			                                  <option value="MO">Missouri</option>
			                                  <option value="MT">Montana</option>
			                                  <option value="NE">Nebraska</option>
			                                  <option value="NV">Nevada</option>
			                                  <option value="NH">New Hampshire</option>

			                                  <option value="NJ">New Jersey</option>
			                                  <option value="NM">New Mexico</option>
			                                  <option value="NY">New York</option>
			                                  <option value="NC">North Carolina</option>
			                                  <option value="ND">North Dakota</option>
			                                  <option value="OH">Ohio</option>

			                                  <option value="OK">Oklahoma</option>
			                                  <option value="OR">Oregon</option>
			                                  <option value="PA">Pennsylvania</option>
											  <option value="PR" >Puerto Rico</option>
			                                  <option value="RI">Rhode Island</option>
			                                  <option value="SC">South Carolina</option>

			                                  <option value="SD">South Dakota</option>
			                                  <option value="TN">Tennessee</option>
			                                  <option value="TX">Texas</option>
			                                  <option value="UT">Utah</option>
			                                  <option value="VT">Vermont</option>
			                                  <option value="VA">Virginia</option>

			                                  <option value="WA">Washington</option>
			                                  <option value="WV">West Virginia</option>
			                                  <option value="WI">Wisconsin</option>
			                                  <option value="WY">Wyoming</option>
			                                </select>            * 
					</td>
				</tr>
				
				<tr>
					<td  >&nbsp;ZipCode: </td>
					<td >
						<input name="shipping[zip]"  required="true"  type="text" class="text"  rel="zip" maxlength="5"  value=""/>*
					</td>
				</tr>
				
				<tr>
					<td  colspan="2" >&nbsp;<input type="submit" value="Continue" /></td>
				</tr>
			</table>
			</form>
			<script>
			<?php
			$data = $_POST['fname']?$_POST:$_SESSION['user'];
			if ($data)
			{
				echo 'var data='.json_encode($data).';';
				?>
				for(var key in data)
				{
					$('[rel='+key+']').val(data[key]);
				}
				<?php
			}
			?>

			function check_form(f)
			{
				var inputs = $(f).find('[required]');
				for(var i = 0; i<inputs.length; i++)
				{
					if (inputs.eq(i).val() == "")
					{
						inputs.get(i).focus();
						return false;
					}
				}

				return true;
			}
			</script>
			<div class="clear"></div>
		</div>
	</div>
	<div class="clear"></div>
</div>
<!-- INCLUDE footer.html -->